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OBJECTIVES: This study is a systematic review of meta-analyses that have addressed the effects of exercise-based interventions alone and the health outcomes (anthropometric, body composition, cardiometabolic, hepatic, vascular, and cardiorespiratory fitness parameters) in overweight and obese children and adolescents. DESIGN: Systematic review of meta-analysis. METHODS: Six electronic sources were searched. The inclusion criteria were: children and/or adolescents classified as overweight or obese, and previous systematic reviews and meta-analyses that included exercise interventions compared to a control group. Standardized mean differences, risk of bias, heterogeneity, and small-study effects were calculated. Subgroup analyses (intervention characteristics) were done. RESULTS: Eighteen meta-analyses met the inclusion criteria. The results showed improvements in some anthropometric and body composition (body mass, BMI, BMI z-score, central obesity, fat mass) and cardiometabolic (TG, fasting glucose, fasting insulin) parameters, and in cardiorespiratory fitness. For the cardiometabolic and vascular parameters, aerobic programs and interventions showed themselves to be effective if they were of four to 12 weeks, or involved a total exercise time of at least 1500min, or involved sessions of at least 60min. CONCLUSIONS: The study provides indications of the appropriate dose of exercise with which to reduce health problems in the obese young population.

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OBJECTIVE: To use a quantitative approach to evaluate the literature for quantity, quality, and consistency of studies of maternal and infant characteristics in association with breastfeeding initiation and continuation, and to conduct a meta-analysis to produce summary relative risks (RRs) for selected factors. STUDY DESIGN: A systematic review using PubMed and CINAHL through March 2016 was conducted to identify relevant observational studies in developed nations, reporting a measure of risk for 1 or more of 6 quantitatively derived, high impact factors in relation to either breastfeeding initiation or continuation. One author abstracted data using a predesigned database, which was reviewed by a second independent author; data evaluation and interpretation included all co-authors. These factors were summarized using standard meta-analysis techniques. RESULTS: Six high impact factors were identified (smoking [39 papers], mode of delivery [47 papers], parity [31 papers], dyad separation [17 papers], maternal education [62 papers], and maternal breastfeeding education [32 papers]). Summary RR from random-effects models for breastfeeding initiation were highest for high vs low maternal education (RR 2.28 [95% CI 1.92-2.70]), dyad connection vs not (RR 2.01 [95% CI 1.38-2.92]), and maternal nonsmoking vs smoking (RR = 1.76 [95% CI 1.59-1.95]); results were similar for breastfeeding continuation. CONCLUSIONS: Despite methodological heterogeneity across studies, relatively consistent results were observed for these perinatally identifiable factors associated with breastfeeding initiation and continuation, which may be informative in developing targeted interventions to provide education and support for successful breastfeeding in more families.

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OBJECTIVE: To investigate the association between ideal cardiovascular health (CVH) metrics and incident cardiovascular disease (CVD) by conducting a systematic review and meta-analysis of prospective cohort studies. METHODS: The MEDLINE, EMBASE, and CINAHL databases were searched from January 1, 2010, through July 31, 2017, for studies that met the following criteria: (1) prospective studies conducted in adults, (2) with outcome data on CVD incidence and (3) a measure of ideal CVH metrics. RESULTS: Twelve studies (210,443 adults) were included in this analysis. Compared with adults who met 0 to 2 of the ideal CVH metrics (high-risk individuals), a significantly lower hazard for CVD incidence was observed in those who had 3 to 4 points for the ideal CVH metrics (hazard ratio [HR]=0.53; 95% CI, 0.47-0.59) and 5 to 7 points (HR=0.28; 95% CI, 0.23-0.33). Weaker associations were observed in studies with older individuals, suggesting that there is a positive relationship between age and HR. CONCLUSION: Although meeting 5 to 7 metrics is associated with the lowest hazard for CVD incidence, meeting 3 to 4 metrics still offers an important protective effect for CVD. Therefore, a realistic goal in the general population in the short term could be to promote at least an intermediate ideal CVH profile (3 to 4 metrics).

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Obese children are usually less active than their normal-weight counterparts, although the reasons for this remain unclear. The objective of the present study was to determine how a long-term program (3 years of intervention and 6 months of follow-up detraining) of physical exercise with or without a low calorie diet influenced sedentary obese children's intention to be physically active. The participants were 27 children, ages from 8 to 11 years, who formed two groups according to the program that they followed. One group followed an exercise program (three 90-min sessions per week), and the other this same exercise program together with a hypocaloric diet. The intention to be physically active was assessed via the Measurement of Intention to be Physically Active (MIFA) questionnaire. The subjects' scores at different times of the program (baseline, Year 3, and detraining) were compared using a repeated-measures ANOVA, and a post-hoc Tukey's test was applied to confirm the differences. After both the intervention and detraining, both groups showed greater intention to be physically active. This suggests the suitability of long-term physical exercise to generate greater intention to be physically active and thus establish healthy life habits including increased levels of physical activity.

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BACKGROUND: Habitual active commuting to school may be positively associated with academic achievement. The aim of this study was to examine the relationship between duration of walking or otherwise actively commuting to school and academic achievement. METHODS: This cross-sectional study included 389 adolescents from seven rural schools (12-13 years). Mode and duration of active commuting to school (use of active means such as walking or biking to and from school) and screen time were self-reported. Academic achievement was determined by the outcome in basic grades (language and mathematics). RESULTS: Active commuting to school was not associated with higher scores in any grades after adjustment for potential confounders. No evidence was found of interactions between gender and academic achievement, but there was interaction with duration of walking (<30 min, 30-60 min, and >60 min). Adjusted binary logistic regression analysis suggested that adolescents who spent between 30 and 60 min actively commuting were more likely to obtain high academic achievement (language and mathematics). CONCLUSIONS: Thirty to 60 min of ACS may have a positive influence on academic achievement in adolescents, so, it is necessary to make recommendations for the children to walk from and/or to school. This could help society to recognize the relevance of physical activity to health as well as to academic performance.

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BACKGROUND: One of the most commonly measured markers of inflammation in clinical settings is C-reactive protein (CRP). The purpose of this meta-analysis was to examine the evidence for the effectiveness of physical exercise interventions on modifying the levels of serum CRP in children and adolescents with excess of weight. METHODS: Two independent reviewers assessed articles from seven databases. Studies were limited to physical exercise interventions in children and adolescents diagnosed as overweight or obese, and including a comparison control group. Weighted mean difference (WMD) was calculated using random-effects model and potential moderators were explored (i.e., weight status, ages, duration of study, frequency of exercise per week, and duration of session). The heterogeneity of the studies was estimated using Cochran's Q-statistic and I(2). RESULTS: Nine randomized controlled trials met the inclusion criteria (n = 427 youths). Overall, results suggest a nonsignificant trend toward a reduction CRP levels (WMD = -0.72 mg/l; 95% confidence interval: -1.52 to 0.08; P = 0.077). Also, there were not significant moderators of exercise effects on CRP. CONCLUSION: These results suggest that exercise programs in children and adolescents not mitigate the inflammatory effects of excess weight, although there was a trend toward reduction.

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OBJECTIVE: To estimate the health and economic impact of feeding partially hydrolyzed formula-whey (PHF-W) instead of standard cow's milk formula (CMF) for the first 4 months of life among US infants at high risk for developing atopic dermatitis (AD). STUDY DESIGN: A Markov model was developed integrating published data, a survey of US pediatricians, costing sources and market data, and expert opinion. Key modeled outcomes included reduction in AD risk, time spent post AD diagnosis, days without AD flare, and AD-related costs. Costs and clinical consequences were discounted at 3% annually. RESULTS: An estimated absolute 14-percentage point reduction in AD risk was calculated with the use of PHF-W compared with CMF (95% CI for difference, 3%-22%). Relative to CMF, PHF-W decreased the time spent post-AD diagnosis by 8.3 months (95% CI, 2.78-13.31) per child and increased days without AD flare by 39 days (95% CI, 13-63) per child. The AD-related, 6-year total cost estimate was $495 less (95% CI, -$813 to -$157) per child with PHF-W ($724 per child; 95% CI, $385-$1269) compared with CMF ($1219 per child; 95% CI, $741-$1824). CONCLUSION: Utilization of PHF-W in place of CMF as the initial infant formula administered to high-risk US infants not exclusively breastfed during the first 4 months of life may reduce the incidence and economic burden of AD. Broad implementation of this strategy could result in a minimum savings of $355 million per year to society.

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BACKGROUND: Patients with fibromyalgia present a reduced capacity of upper and lower limb physical performance and affect their independence in performing everyday activities. OBJECTIVE: The purpose of the present systematic review was to summarize evidence for the effectiveness and structure of exercise programs on functional aerobic capacity in patients with fibromyalgia syndrome. METHODS: Keyword searches were made of seven databases. The systematic review was limited to English language studies of people with FM that evaluated the effects of exercise programs on functional aerobic capacity (6-minute walk test). RESULTS: The criteria for inclusion were satisfied by 12 randomized controlled trial (RCT) studies. The main cumulative evidence indicates that the programs based on aerobic exercise alone and on aquatic exercises have large (effect size = 0.85) and moderate (effect size = 0.44) effects. CONCLUSIONS: Aerobic and aquatic exercises at the proper intensity favour the increased functional aerobic capacity of fibromyalgia patients; however, most works do not adequately detail the intensity of the exercises. Moderate intensity exercise (aerobic and aquatic exercise) performed at least two times per week and 30-60 minutes a day is effective for increasing functional aerobic capacity, favouring the daily activities of daily living in this population.

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Introducción. El desentrenamiento es la pérdida de las mejoras obtenidas por el ejercicio físico/ entrenamiento tras su cese, aspecto poco estudiado en población infantil obesa. Así, el propósito del presente estudio fue evaluar los efectos del desentrenamiento sobre el perfil lipídico (HDL, LDL, colesterol total y triglicéridos) en niños obesos. Población y métodos. Los estudios fueron recuperados mediante la búsqueda en siete bases de datos. Dicha búsqueda se limitó a programas de ejercicio físico de, al menos, ocho semanas de duración y su desentrenamiento, y se evaluó el perfil lipídico de niños obesos. Se calculó el tamaño del efecto (TE), sus intervalos de confianza del 95% y la heterogeneidad de los estudios a través de la Q de Cochrane (modelo de efectos aleatorios). Resultados. Cinco estudios cumplieron los criterios de inclusión y fueron seleccionados para su revisión (n= 330). En general, los resultados intragrupo (postest vs. desentrenamiento) mostraron que, tras el desentrenamiento, el nivel en sangre del colesterol HDL (TE= 0,12) y el colesterol total aumentaron (TE= 1,41). Del mismo modo, los resultados intergrupo (grupo experimental vs. grupo control) confirmaron el aumento del colesterol HDL tras el desentrenamiento (TE= 0,49). Conclusiones. Los resultados de esta revisión sistemática sugieren que el desentrenamiento tras un programa de ejercicio físico no genera una pérdida significativa de los beneficios obtenidos sobre el perfil lipídico de los niños obesos. No obstante, debido al número de estudios analizados y a la heterogeneidad observada en los análisis y en el tiempo considerado como desentrenamiento (de 12 a 48 semanas), se requiere un mayor número de estudios de calidad para obtener resultados más concluyentes.(AU)

Introduction. Detraining is the loss of improvements obtained through the participation in physical exercise/training after training cessation, an aspect that has been poorly studied in obese child population. Therefore, the purpose of this study was to assess the effects of detraining on the lipid profile (HDL, LDL, total cholesterol and triglycerides) of obese children. Population and Methods. Studies were collected through a search across sevendatabases. The search was limited to physical exercise programs that lasted, at least, eight weeks and the corresponding detraining, with an assessment of obese children lipid profile. Effect size (ES), 95% confidence intervals and study heterogeneity were estimated using Cochrans Q test (random effects model). Results. Five studies complied with the inclusion criteria and were selected for review (n= 330). In general, intra-group results (posttest versus detraining) indicated that, following detraining, blood levels of HDL cholesterol (ES= 0.12) and total cholesterol (ES= 1.41) were increased. Likewise, inter-group results (experimental group versus control group) confirmed the increase of HDL cholesterol following detraining (ES= 0.49). Conclusions. The results of this systematic review suggest that detraining after a physical exercise program does not lead to a significant loss of the benefits gained in relation to the lipid profile of obese children. However, given the number of analyzed studies and the heterogeneity observed in the analyses and the period defined as detraining (12 to 48 weeks), a higher number of well designed studies is required to obtain more conclusive results.(AU)

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Introducción. El desentrenamiento es la pérdida de las mejoras obtenidas por el ejercicio físico/ entrenamiento tras su cese, aspecto poco estudiado en población infantil obesa. Así, el propósito del presente estudio fue evaluar los efectos del desentrenamiento sobre el perfil lipídico (HDL, LDL, colesterol total y triglicéridos) en niños obesos. Población y métodos. Los estudios fueron recuperados mediante la búsqueda en siete bases de datos. Dicha búsqueda se limitó a programas de ejercicio físico de, al menos, ocho semanas de duración y su desentrenamiento, y se evaluó el perfil lipídico de niños obesos. Se calculó el tamaño del efecto (TE), sus intervalos de confianza del 95% y la heterogeneidad de los estudios a través de la Q de Cochrane (modelo de efectos aleatorios). Resultados. Cinco estudios cumplieron los criterios de inclusión y fueron seleccionados para su revisión (n= 330). En general, los resultados intragrupo (postest vs. desentrenamiento) mostraron que, tras el desentrenamiento, el nivel en sangre del colesterol HDL (TE= 0,12) y el colesterol total aumentaron (TE= 1,41). Del mismo modo, los resultados intergrupo (grupo experimental vs. grupo control) confirmaron el aumento del colesterol HDL tras el desentrenamiento (TE= 0,49). Conclusiones. Los resultados de esta revisión sistemática sugieren que el desentrenamiento tras un programa de ejercicio físico no genera una pérdida significativa de los beneficios obtenidos sobre el perfil lipídico de los niños obesos. No obstante, debido al número de estudios analizados y a la heterogeneidad observada en los análisis y en el tiempo considerado como desentrenamiento (de 12 a 48 semanas), se requiere un mayor número de estudios de calidad para obtener resultados más concluyentes.

Introduction. Detraining is the loss of improvements obtained through the participation in physical exercise/training after training cessation, an aspect that has been poorly studied in obese child population. Therefore, the purpose of this study was to assess the effects of detraining on the lipid profile (HDL, LDL, total cholesterol and triglycerides) of obese children. Population and Methods. Studies were collected through a search across sevendatabases. The search was limited to physical exercise programs that lasted, at least, eight weeks and the corresponding detraining, with an assessment of obese children lipid profile. Effect size (ES), 95% confidence intervals and study heterogeneity were estimated using Cochran's Q test (random effects model). Results. Five studies complied with the inclusion criteria and were selected for review (n= 330). In general, intra-group results (posttest versus detraining) indicated that, following detraining, blood levels of HDL cholesterol (ES= 0.12) and total cholesterol (ES= 1.41) were increased. Likewise, inter-group results (experimental group versus control group) confirmed the increase of HDL cholesterol following detraining (ES= 0.49). Conclusions. The results of this systematic review suggest that detraining after a physical exercise program does not lead to a significant loss of the benefits gained in relation to the lipid profile of obese children. However, given the number of analyzed studies and the heterogeneity observed in the analyses and the period defined as detraining (12 to 48 weeks), a higher number of well designed studies is required to obtain more conclusive results.

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INTRODUCTION: Detraining is the loss of improvements obtained through the participation in physical exercise/training after training cessation, an aspect that has been poorly studied in obese child population. Therefore, the purpose of this study was to assess the effects of detraining on the lipid profile (HDL, LDL, total cholesterol and triglycerides) of obese children. POPULATION AND METHODS: Studies were collected through a search across seven databases. The search was limited to physical exercise programs that lasted, at least, eight weeks and the corresponding detraining, with an assessment of obese children lipid profile. Effect size (ES), 95% confidence intervals and study heterogeneity were estimated using Cochran's Q test (random effects model). RESULTS: Five studies complied with the inclusion criteria and were selected for review (n= 330). In general, intra-group results (posttest versus detraining) indicated that, following detraining, blood levels of HDL cholesterol (ES= 0.12) and total cholesterol (ES= 1.41) were increased. Likewise, inter-group results (experimental group versus control group) confirmed the increase of HDL cholesterol following detraining (ES= 0.49). CONCLUSIONS: The results of this systematic review suggest that detraining after a physical exercise program does not lead to a significant loss of the benefits gained in relation to the lipid profile of obese children. However, given the number of analyzed studies and the heterogeneity observed in the analyses and the period defined as detraining (12 to 48 weeks), a higher number of well designed studies is required to obtain more conclusive results.

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Semen analysis is the first step in the evaluation of an infertile couple. Within this process, an accurate and objective morphological analysis becomes more critical as it is based on the correct detection and segmentation of human sperm components. In this paper, we present an improved two-stage framework for detection and segmentation of human sperm head characteristics (including acrosome and nucleus) that uses three different color spaces. The first stage detects regions of interest that define sperm heads, using k-means, then candidate heads are refined using mathematical morphology. In the second stage, we work on each region of interest to segment accurately the sperm head as well as nucleus and acrosome, using clustering and histogram statistical analysis techniques. Our proposal is also characterized by being fully automatic, where a user intervention is not required. Our experimental evaluation shows that our proposed method outperforms the state-of-the-art. This is supported by the results of different evaluation metrics. In addition, we propose a gold-standard built with the cooperation of a referent expert in the field, aiming to compare methods for detecting and segmenting sperm cells. Our results achieve notable improvement getting above 98% in the sperm head detection process at the expense of having significantly fewer false positives obtained by the state-of-the-art method. Our results also show an accurate head, acrosome and nucleus segmentation achieving over 80% overlapping against hand-segmented gold-standard. Our method achieves higher Dice coefficient, lower Hausdorff distance and less dispersion with respect to the results achieved by the state-of-the-art method.

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INTRODUCTION: Detraining is the loss of improvements obtained through the participation in physical exercise/training after training cessation, an aspect that has been poorly studied in obese child population. Therefore, the purpose of this study was to assess the effects of detraining on the lipid profile (HDL, LDL, total cholesterol and triglycerides) of obese children. POPULATION AND METHODS: Studies were collected through a search across seven databases. The search was limited to physical exercise programs that lasted, at least, eight weeks and the corresponding detraining, with an assessment of obese children lipid profile. Effect size (ES), 95

confidence intervals and study heterogeneity were estimated using Cochrans Q test (random effects model). RESULTS: Five studies complied with the inclusion criteria and were selected for review (n= 330). In general, intra-group results (posttest versus detraining) indicated that, following detraining, blood levels of HDL cholesterol (ES= 0.12) and total cholesterol (ES= 1.41) were increased. Likewise, inter-group results (experimental group versus control group) confirmed the increase of HDL cholesterol following detraining (ES= 0.49). CONCLUSIONS: The results of this systematic review suggest that detraining after a physical exercise program does not lead to a significant loss of the benefits gained in relation to the lipid profile of obese children. However, given the number of analyzed studies and the heterogeneity observed in the analyses and the period defined as detraining (12 to 48 weeks), a higher number of well designed studies is required to obtain more conclusive results.

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OBJECTIVE: To describe atopic dermatitis (AD) management patterns in children ≤36 months old as reported by pediatricians, dermatologists, and allergists in the US. STUDY DESIGN: A nationally-representative survey was administered to pediatricians (n = 101), dermatologists (n = 26), and allergists (n = 26). Main outcomes included referrals to health care professionals, suggested/ordered laboratory tests, management approach (dietary, pharmacologic, or combination of both) by age, AD location, and severity. RESULTS: Significant differences were observed in referrals to healthcare professionals (P < .001). Pediatricians more frequently referred to dermatologists than allergists in mild (52.4% vs 32.0%) and moderate/severe (60.6% vs 38.1%) cases. Dermatologists referred to allergists less frequently for mild (9.1%) than moderate/severe (40.7%) AD cases. Pediatricians (59%), allergists (61.5%), and dermatologists (26.9%) reported treating at least some of their patients with AD with dietary management (infant formula change) alone (with or without emollients). Soy-based formulas were often used. For mild AD, the most commonly reported first-line pharmacologic treatments included topical emollients, topical corticosteroids, and barrier repair topical therapy/medical devices. Over 80% of physicians used a dietary and pharmacologic combination approach. Dermatologists were most likely to manage AD symptoms with a pharmacologic-only approach. AD lesion location influenced pharmacologic treatment in >80% of physicians. CONCLUSIONS: Significant and distinct differences in AD treatment approach exist among physicians surveyed. Most pediatricians and allergists use formula change as a management strategy in some patients, whereas dermatologists favor a pharmacologic approach. This diversity may result from inadequate evidence for a standard approach. Consistent methods for managing AD are needed.

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Several factors leading to obesity have been identified, which start at very early stages of life. Although there are genetic contributors and socioeconomic and racial disparities in the prevalence of overweight and obesity, the problem is universal. Children's weight has been associated to multiple specific diet factors and these, in turn, are associated to specific "parent feeding practices" (PAPP, Spanish abbreviation). Parents or caretakers determine patterns that are set at an early stage in life, and the weight before the first two years of age already predicts future overweight and obesity. Absence of breastfeeding and low food quality, consumption patterns and food preferences in the first two years of life are highly associated to PAPP and can, therefore, be modified. In this article, we will examine the diet factors and the diet-related practices that have been associated to child obesity, and are potentially modifiable, so that they can be used as a potential guide for intervention goals in the prevention of child obesity.

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Son varios los factores identificados que llevan a la obesidad, cuyo origen se da desde etapas muy tempranas de la vida. Aunque existen contribuyentes genéticos y disparidades socioeconómicas y raciales en la frecuencia de sobrepeso y obesidad, el problema es universal. El estado ponderal de los niños se ha asociado con múltiples factores dietéticos específicos y estos, a su vez, están asociados con específicas “prácticas de alimentación por parte de los padres” (PAPP). Los padres o cuidadores determinan patrones que se establecen muy temprano en la vida, y el peso antes de los dos años de vida predice ya el sobrepeso u obesidad futura. La falta de lactancia materna y la baja calidad de los alimentos, los patrones de consumo y las preferencias por alimentos en los primeros dos años de vida, son altamente dependientes de las PAPP y, por tanto, son también modificables. En este artículo vamos a examinar los factores dietéticos y las prácticas relacionadas con la dieta que han sido asociadas con la obesidad infantil, y que son potencialmente modificables, de forma que sirvan como guía potencial para metas de intervención, en la prevención de la obesidad infantil.

Several factors leading to obesity have been identified, which start at very early stages of life. Although there are genetic contributors and socioeconomic and racial disparities in the prevalence of overweight and obesity, the problem is universal. Children’s weight has been associated to multiple specific diet factors and these, in turn, are associated to specific “parent feeding practices” (PAPP, Spanish abbreviation). Parents or caretakers determine patterns that are set at an early stage in life, and the weight before the first two years of age already predicts future overweight and obesity. Absence of breastfeeding and low food quality, consumption patterns and food preferences in the first two years of life are highly associated to PAPP and can, therefore, be modified. In this article, we will examine the diet factors and the diet-related practices that have been associated to child obesity, and are potentially modifiable, so that they can be used as a potential guide for intervention goals in the prevention of child obesity.

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Early bacterial stimulation of gut associated immune cells is essential for the development and maturation of the infant's immune response. This "microbial experience" has been affected due to a decrease in vaginal births (which are the first source of bacterial exposure for an infant), the substitution of breast feeding, in favor of almost sterile formulas, an increase use of antibiotics, and an increasingly "cleaner" environment. Increased hygienic measures and pasteurization perpetuate this decreased microbe-host interaction. These changes in environmental and gut microbiota are associated with an altered and inadequate development of immune response, with related health implications. The inadequate host response to infectious diseases, as well as the epidemic of immune related chronic conditions (such as allergy) can be explained in great measure by these changes. The consumption of certain probiotics (specific dietary bacteria that provide a benefit to the host) has positive effects on gut barrier function and immune response. Thus, probiotics are a means of improving host-microbe interactions for health maintenance, and for the management of a number of illnesses. This paper summarizes important aspects of these interactions as well as the role that probiotic bacteria can play in pediatric health.

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